Schedule 1
PRESCRIBED FORMS
1 / 4(1)(d) / Application for exemption by the Minister
2 / 45(1) / Application for registration as credit provider
3 / 41(1) / Application for supplementary registration
4 / 44(1) / Application for registration as debt counsellor
5 / 43(1) / Application for registration as credit bureau
6 / 47(3)(a) / Notice when registrant becomes disqualified
7 / 48(3) / National Credit Regulator imposing conditions of registration
8 / 49(1)(a) / Registrant requesting new conditions
9 / 52(1) / Certificate of registration
10 / 58 / Notice to cancel
11 / 25(1)(b) / Certificate to inspectors / investigators
12 / 54(1) / Notice of non-compliance to unregistered entities
13 / 55(1) / Compliance notice to registrants
14 / 56(1) / Objection notice
15 / 78(2) / Reporting to National Credit Regulator on loans excluded from reckless provisions
16 / 86(1) / Application for debt review
17.1 / 86(4)(b) / Notification to credit provider and credit bureau by debt counsellor of application for debt review
17.2 / Notification to credit provider and credit bureau by debt counsellor of rejection or restructuring
18 / 86(9) / Application to court for debt review by consumer
19 / 71(2)(b)(i) / Clearance certificate
20 / 92(1) / Pre-agreement statement and quotation for small agreement
20.1 / 92(2) / Quotation for intermediate and large agreements
20.2 / 93(2) / Small agreements
21 / 106(5)(b) / Disclosure to consumer in respect of insurance
22 / 106(6)(a) / Authorisation by consumer to credit provider in respect of insurance
23 / 106(6)(b) / Nomination & authority granted by consumer to insurance company
24 / 97(2) / Notification of change to credit provider
25 / 97(3) / Notification of change
26 / 109(2) / Statement of account for small agreements
27 / 124(2) / Notice of charge to other account to consumer by credit provider
28 / 134(5) / Failed Alternative Dispute Resolution certificate
29 / 136(1) / Complaint form
30 / 137(1) / Application by National Credit Regulator to National Consumer Tribunal
31 / 139(1)(a) / Notice of non-referral
32 / 140(4) / Application to National Consumer Tribunal
33 / 141(2)(a) / Application to National Consumer Tribunal
34 / 53(1) / National Credit Regulator’s register of registrant
34.1 / 53(1)(b) / National Credit Regulator’s register of provincial registrants
35 / 14(c)(ii) / Request for info in registries
36 / 74(7)(a) / Register of marketing selection made by consumer
37 / 163(2)(b) / Register of Agents
38 / 163(2)(a) / Agents’ Identity card
39 / Credit provider’s statistical return
40 / Credit provider’s annual financial and operational return
41 / Compliance return for debt counsellors
42 / Statistical return for debt counsellors
43 / Credit bureaux’ annual compliance
44 / 70(5)(a) / Credit bureaux’ synoptic report
45 / 16(2)(a) / Insurers’ periodic synoptic report
NCR Form 1
Application for exemption by the Minister in terms of section 4(1)(d)
APPLICATION FOR EXEMPTION BY THE MINISTER IN TERMS OF SECTION 4(1)(d) OF THE NATIONAL CREDIT ACT 34 OF 2005
Name of Applicant
Address of Applicant
Tel Number
Name of Credit Provider
Address of Credit Provider
Code: (
)
To The Minister of Trade and Industry
Address
Code: (
)
I, the above mentioned Applicant, hereby request approval from the Minister of Trade and Industry to exempt the proposed credit agreement to be entered into between myself and the above mentioned credit provider located outside of the Republic of South Africa.
The parties to the agreement:
The type of credit agreement:
The amount of credit transaction:
The general terms and conditions:
Signed at [place]
on this [day]
of [month]
of [year]
Signature
Full Name of Signatory
NCR Form 2
Application for registration as credit provider in terms of section 45(1)
APPLICATION FORM FOR REGISTRATION AS A CREDIT PROVIDER IN TERMS OF SECTION 45 OF THE NATIONAL CREDIT ACT 34 OF 2005
General information
The applicant must submit the completed application form, together with the required documentation and application fee to the National Credit Regulator.
PART 1 — APPLICANT’S INFORMATION
Instructions:
1.
Name of Applicant
2.
Trading name of applicant
3.
Legal Status
3.1
Individual
3.2
Trust
3.3
Private Company
3.4
Public Company
3.5
Partnership
3.6
Close Corporation
3.7
Co-operative
3.8
Other (specify)
4.
CIPRO/other official registration number
5.
Date of commencement of trading
6.
Financial Year-End
7.
Income Tax registration number
8.
VAT registration number (if applicable)
9.
Which, if any, other regulated activity does the applicant engage in?
9.1
Banking
9.2
Insurance
9.3
Debt Collectors
9.4
Financial Advisory
9.5
Other (specify)
10.
Contact detail of the Applicant
Physical Address
Postal Code
Postal Address
Postal Code
Telephone number (
)
Fax number (
)
e-mail address (if applicable)
11.
Contact person
Title
Name and initials
Surname
Telephone number (office) (
)
e-mail address (if applicable)
12.
Auditor /Accounting Officer
Name of Firm
Postal Address
Postal Code
Physical Address
Postal Code
Name of Auditor or Accountant
Telephone number (
)
Fax number (
)
e-mail address (if applicable)
Practice number
Name of professional body registered with
13.
Compliance Officer (if applicable)
Name of Compliance Officer
Telephone number (
)
Fax number (
)
e-mail address
If external compliance officer, name of firm
Postal Address
Postal Code
Telephone number (
)
14.
Products
14.1
Mortgage agreements
14.2
Credit facilities
14.3
Unsecured credit transactions
14.4
Vehicle finance
14.5
Clothing retail
14.6
Furniture retail
14.7
Pawnbroking
14.8
Developmental Credit
(Editorial Note: Numbering as per Government Gazette)
14.10
Other products, specify
15.
Which of the following ancillary financial products does the Applicant sell in conjunction with its credit products?
15.1
Life Insurance
15.2
Funeral cover
15.3
Credit Life Insurance
15.4
Short term insurance
15.5
Other, specify
16.
In terms of section 63 of the National Credit Act 34 of 2005, a credit provider must make a submission to the National Credit Regulator to make documents available to consumers in at least 2 official languages.
1 / 2 / 3
Description of main area in which you operate with reference to area with in the province:
1st Language:
2nd Language:
If more than 3 areas, add additional pages.
17.
Compliance with section 48(1)(a) and (b) of the National Credit Act.
17.1
Please indicate the Applicant’s commitments, if any, made with regard to the Broad Based Black Economic Empowerment Act, 2003 (Act No. 53 of 2003)(add additional pages if required)
17.2
Please indicate the Applicant’s commitments, if any, made with regard to the combating of over-indebtedness (add additional pages if required)
PART 2 — FINANCIAL INFORMATION
The following financial information must reflect the value of credit agreements as defined in the National Credit Act. It should exclude credit agreements to which the Act does not apply as indicated in Section 4.
1.
Net value of loan book as at the end of the most recent financial year end
R
2.
Total number of credit agreements that made up the loan book as at the end of the most recent financial year
3.
Total value (principal debt) of credit agreements entered into during the most recent financial year
R
4.
Total number of credit agreements entered into during the most recent financial year
PART 3 — MEMBERS, DIRECTORS, TRUSTEES, PARTNERS AND GENERAL MANAGERS OF THE APPLICANT
1.
For the purpose of Part 3 and Part 7, refer to the definition of “management or control” in the Regulations.
2.
Does the Applicant or any natural person exercising general management or control whether alone or in conjunction with others, hold a controlling interest in any of the following businesses:
A credit bureau
Yes
No
A debt collection agency
Yes
No
An alternative dispute resolution agent
Yes
No
A credit repair agency
Yes
No
3.
If the answer to any of the above is “yes”, please provide details:
PART 4 — BUSINESS PREMISES
THIS FORM MUST BE COMPLETED IN RESPECT OF ALL BUSINESS PREMISES FROM WHICH THE APPLICANT CONDUCTS / INTENDS TO CONDUCT THE BUSINESS OF A CREDIT PROVIDER MAKE ADDITIONAL COPIES IF REQUIRED.
1.
Total number of business premises
2.
Information required per business premises
Trading name
Physical Address
Postal Code
Contact person
Telephone number (
)
Fax number (
)
E-mail address
Trading name
Physical Address
Postal Code
Contact person
Telephone number (
)
Fax number (
)
E-mail address
PART 5 — SUPPLEMENTARY REGISTRATION IN TERMS OF SECTION 41 OF THE ACT
1.
If this application includes an application for supplementary registration to provide developmental credit, please state which of the following types of developmental credit will be provided:
1.1
Co-operative loans to members
1.2
Educational Credit
1.3
Small Business Credit
1.4
Low Income Housing Credit
1.5
Other, specify
2.
Human, financial and operational resources
In a separate document to be attached to the supplementary registration form, either:
(a)
explain in detail why the credit provider believes that it’s human, financial and operational resources are sufficient to enable the applicant to function efficiently and effectively carry out its function in terms of the Act, or
(b)
present a credible plan to the National Credit Regulator to acquire or develop sufficient human, financial and operational resources to enable the applicant to function efficiently and effectively carry out its function in terms of the Act
3.
Administrative Procedures
In a separate document to be attached to the supplementary registration form, either:
(a)
explain in detail why the credit provider believes that it has adequate administrative procedures and safeguards to justify the application of statutory exceptions from this Act, or
(b)
present a credible plan to the National Credit Regulator to develop adequate administrative procedures and safeguards to justify the application of statutory exceptions from this Act before entering into any developmental credit agreement.
4.
In a separate document to be attached to the supplementary registration form, indicate what measures have been put in place / will be put in place to ensure that credit extended to consumers will be used for developmental purposes only.
5.
Total number of business premises
PART 6 — DECLARATION BY CREDIT PROVIDER
1.
The applicant hereby permits the National Credit Regulator or any person authorised by the National Credit Regulator, as set out in section 50(2)(a) to enter any place at or from which the applicant conducts the registered activities during normal business hours, and to conduct reasonable inquiries for compliance purposes, including any act contemplated in section 156(1)(d) to (h) of the Act.
2.
The applicant confirms that the information contained in this application is accurate and complete.
Date:
Duly authorised representative: / Name
Signature
Capacity
If this application is completed on behalf of a juristic person, attach proof of authorisation.
PART 7 — DISQUALIFICATION OF NATURAL PERSONS
THE APPLICANT NEED NOT COMPLETE THIS PART IN THE CASE WHERE THE APPLICANT IS A BANK AS DEFINED IN THE BANKS ACT 1990, ACT NO 94 OF 1990,
THIS FORM MUST BE COMPLETED AND SIGNED IN RESPECT OF EACH NATURAL PERSON WHO EXERCISES GENERAL MANAGEMENT OR CONTROL OF THE APPLICANT, WHETHER ALONE OR IN CONJUNCTION WITH OTHERS MAKE ADDITIONAL COPIES.
Name of natural person completing form:
Identity number:
Date:
Questions:
1.
Are you, as a result of a court order, listed on the register of excluded persons in terms of section 14 of the National Gambling Act; 2004 (Act no 7 of 2004) / Yes / No
2.
Are you subject to an order of a competent court holding you to be mentally unfit of disordered? / Yes / No
3.
Have you ever been removed from office on account of misconduct relating to fraud or the misappropriation of money, whether in the Republic or elsewhere? / Yes / No
4.
Have you ever been a director or member of a governing body of an entity at the time that such entity has been de-registered in terms of public regulation? / Yes / No
5.
Have you ever been a director or member of a governing body of an entity at the time that such entity has brought the consumer credit industry into disrepute? / Yes / No
6.
Have you ever been a director or member of a governing body of an entity at the time that such entity has acted with disregard for consumer rights generally? / Yes / No
7.
Have you ever been convicted during the previous ten years, in the Republic or elsewhere, of theft, fraud, forgery or uttering a forged document, perjury, or an offence under the Corruption Act, 1992 (Act No 94. of 1992), or comparable legislation of another jurisdiction and been sentenced to imprisonment without the option of a fine? / Yes / No
If your answer is yes, when providing full details in respect thereof, indicate whether you received a grant of amnesty or free pardon for the offence
8.
Have you ever been convicted during the previous ten years, in the Republic or elsewhere, of a crime involving violence against another natural person and been sentenced to imprisonment without the option of a fine? / Yes / No
If your answer is yes, when providing full details in respect thereof, indicate whether you received a grant of amnesty or free pardon for the offence.
9.
Have you ever been convicted during the previous ten years, in the Republic or elsewhere, of an offence in terms of this Act, a repealed law or comparable provincial legislation and been sentenced to imprisonment without the option of a fine? / Yes / No
If your answer is yes, when providing full details in respect thereof, indicate whether you received a grant of amnesty or free pardon for the offence.
10.
I, the undersigned, hereby give permission to the SAPS Criminal Record Centre to furnish the National Credit Regulator or it’s authorised agents with my previous convictions and any relevant information in their possession, including any directions by the Court for my detention in a mental hospital or prison as well as any court order listing myself on the register of excluded persons in terms of the National Gambling Act, if any, in the form SAPS69 / Yes / No
I hereby indemnify the SAPS Criminal Record Centre, its employees, the National Credit Regulator, its agents and its employees and hold them harmless against any claims by myself or any other person that may arise out of or be connected with such disclosure as well as any legal costs, including attorney and client costs.
11.
I certify that the information contained herein is true and correct.
Signature
NCR Form 3
Application for supplementary registration in terms of section 41(1)